When you examine a patient who has hearing loss you should ask them how they would prefer you to communicate with them.

You should allow an appropriate amount of extra time for the consultation.

To help with communication, you should:

• face the patient and maintain eye contact to enable the patient to lip read
• keep your hands away from your face when talking. Be aware that beards and moustaches can also make it more difficult for people to lip read
• speak slowly, clearly and distinctly, but do not exaggerate mouth movements. Use short sentences where possible, and pause between sentences
• not shout
• minimise background noise if possible
• watch for the facial expressions that may indicate that the patient has not understood you, and rephrase what you have said rather than repeating it
• only turn the consulting room lights off when needed, and tell the patient before turning the lights off. Do not put the refractor head in front of the patient’s face until necessary. Where possible, move the refractor head away from the patient when speaking to them
• be patient, and repeat what you have said where necessary
• provide clear and accessible written advice if you are not confident that the patient has understood your verbal advice.  

(Also see sections on Examining patients with learning disabilities, Examining autistic patients and Examining patients with specific learning difficulties). 

If the patient has age-related hearing loss, they may find it more difficult to hear higher pitched voices, such as women’s and children’s voices. You can help these patients to hear you by lowering your voice.

You should explain what you are going to do before you do it, for example before asking the patient to put their head on the slit lamp, or bringing the refractor head in front of their face. 

If the patient prefers to communicate using an interpreter,³⁴ you should use a relevant accredited interpreter to protect both you and the patient. If the patient is an NHS patient you may contact your local NHS organisation to see what arrangements they have for providing this service. You may choose to use a video-interpreting service, using a video phone or other device.³⁵ You should talk directly to the patient rather than the interpreter. 

If you use pen and paper to help communicate, remember that patients who use British Sign Language (BSL) do not have English as their first language. You should therefore use shorter, simpler words and sentences where possible.

The BSL fingerspelling alphabet is useful to help communicate with deaf patients.